Long-term health risks and benefits of the copper coil

When choosing a form of contraception there are a lot of things to consider, from side effects to whether or not you want short or long-term protection. Given the wealth of information out there it is often hard to choose. But when you have made your decision, do you ever stop to wonder if there may be long-term effects on your health?

The non-hormonal copper coil is one of the intrauterine device (IUD) methods of contraception that is placed in the womb (uterus). The copper coil does not involve hormones in its method of action, which can be an attractive feature for women when considering contraception. For example, some women may seek a non-hormonal option if they have had unwanted side effects as a result of the combined contraceptive pill, which contains oestrogen and progesterone. Furthermore, there is no evidence of weight gain, altered libido, or mood changes with copper coil.1

The copper coil is a very small T-shaped device that is inserted during a 10-minute consultation and placed by your doctor or family planning trained nurse. It is designed to sit inside your uterus. While in place, the copper coil slowly releases copper which acts to kill sperm.

The pros

A more effective form of emergency contraception than the morning after pill, the copper coil can also be placed up to five days after unprotected sex to prevent pregnancy. Another benefit of the copper coil is its suitability for use during breastfeeding, but these women will have to wait four to six weeks after giving birth for the coil to be fitted.

The benefits of the copper coil also lie in the long-acting effects (5 to 10 years), meaning there is no requirement to remember to take a pill once daily. Therefore, if you realise you are not wonderful at regular pill-taking, then the copper coil would provide you with a reliable longer-term contraceptive option, and can help in reducing any last minute panic about forgotten pills.

Additionally, during the crucial moment when having sex (and for 5 to 10 years), you do not need to think about contraception, and your partner should not be able to feel the coil during sex. The copper coil, however, will not protect you from a sexually transmitted infection: you should use a condom if you believe you may be exposed to an infection.

From a medical perspective, the copper coil does not interact with any other medicines you may currently be taking. Furthermore, if you have the copper coil in place and are considering starting your family in the short term, the good news is that your fertility returns to normal instantly once the copper coil is removed, ensuring no delays to your reproductive plans. Women who have had an ectopic pregnancy, women with a known allergy to copper, and women with pelvic inflammatory disease, fibroids, artificial heart valve, or unexplained vaginal bleeding should consult with their clinician to discuss alternative options, as they are medically unsuitable for the copper coil.

The risks

While there are many benefits to the copper coil, occasionally some women find they experience unwanted effects from it.

Short-term (first three months) unwanted effects of the coil may include cramp-type pain in the pelvis (dysmenorrhoea), which may settle after the initial three-month period. Menstrual cramps can be treated with anti-inflammatory painkillers, such as ibuprofen, diclofenac, or naproxen, and these also act to reduce bleeding.

There may also be some irregular bleeding which should settle after the initial six months. Dysmenorrhoea can persist longer term (over six months) for some women. Persistent cramps that are resistant to anti-inflammatory treatment is one of the most common reasons for opting to have the coil removed.

Heavy bleeding

The menstrual blood flow may become heavier once the copper coil has been placed, as copper exerts an inflammatory irritant effect on the uterus lining, causing slightly more bleeding as a consequence. This is something to consider, particularly if you have heavy periods prior to having the copper coil, as you could find this contraceptive method increases the menstrual blood flow even further.

This heavier menstrual flow often settles within a few months following the coil insertion, and so it is wise to weigh up if you think that you are prepared to persevere with the potential heavier menstrual flow. In some cases, the heavy bleeding can persist long term, with potential to have emotional and social impact.

Long-term complications of having the copper coil are associated with the effects of heavy menstrual bleeding over a period of twelve months or longer, due to reduced iron stores in the body. If you feel more lethargic and tired, always feel cold, have poorer concentration, you are vegan or vegetarian, or you currently eat a poorly balanced diet rich in takeaways or convenience food, then the risk of developing iron deficiency anaemia is higher. Methods to counterbalance this include eating an iron-rich diet, including foods such as leafy green vegetables, nuts, beef, lamb, and shellfish.

A further consequence of heavy bleeding long term can include disruptions to everyday life. You may find you leak onto clothes, onto bedding, or have to use a combination of tampons and towels which you have to change very regularly. This can result in feeling reluctant to leave the house, or it could affect your work life, and you may experience feeling low. If this is the case, visit your GP who may prescribe you tranexamic acid tablets (that can be taken with ibuprofen), which act to reduce bleeding. The GP may also wish to monitor your mood, and perform blood tests to rule out rare causes of heavy bleeding, including blood clotting disorders or thyroid disorders.

As with any type of contraception there are many benefits and some potential side effects which mean it may not work for you. Ensuring awareness about long-term effects can help assist you in making the right choice. Your GP or a practitioner at a family planning clinic can help you choose and give you more advice on all the options out there.

Lorna is a doctor by trade, and now works in the pharmaceutical industry. She enjoyed writing throughout her medical degree and she worked on numerous health-based writing projects, including medical research and writing articles for medical journals, while working as a hospital doctor for the NHS. She is excited to be able to reach a much wider audience with her writing for The Femedic and hopes readers will find greater clarity on health issues from reading her articles.